Surgical results and prognostic factors following percutaneous full endoscopic posterior decompression for thoracic myelopathy caused by ossification of the ligamentum flavum

Background and Objectives: Ossification of the ligamentum flavum (OLF) is a relatively common cause of thoracic myelopathy. Surgical treatment is recommended for patients with myelopathy. Generally, open posterior decompression, with or without fusion, is selected to treat OLF. We performed minimally invasive posterior decompression using a microendoscope and investigated the efficacy of this approach in treating limited type of thoracic OLF. Materials and Methods: Microendoscopic posterior decompression was performed for 19 patients (15 men and four women) with thoracic OLF with myelopathy aged between 35 to 81 years (mean age, 61.9 years). Neurological examination and preoperative magnetic resonance imaging (MRI) and computed tomography (CT) were used to identify the location and morphology of OLF. The surgery was performed using a midline approach or a unilateral paramedian approach depending on whether the surgeon used a combination of a tubular retractor and endoscope. The numerical rating scale (NRS) and modified Japanese Orthopedic Association (mJOA) scores were compared pre- and postoperatively. Perioperative complications and the presence of other spine surgeries before and after thoracic OLF surgery were also investigated. Results: Four midline and 15 unilateral paramedian approaches were performed. The average operative time per level was 99 min, with minor blood loss. Nine patients had a history of cervical or lumbar spine surgery before or after thoracic spine surgery. The mean pre- and postoperative NRS scores were 6.6 and 5.3, respectively. The mean recovery rate as per the mJOA score was 33.1% (mean follow-up period, 17.8 months), the recovery rates were significantly different between patients who underwent thoracic spine surgery alone (50.5%) and patients who underwent additional spine surgeries (13.7%). Regarding adverse events, one patient experienced dural tear, another experienced postoperative hematoma, and one other underwent reoperation for adjacent thoracic stenosis. Conclusion: Microendoscopic posterior decompression was applicable in limited type of thoracic OLF surgery including beak-shaped type and multi vertebral levels. However, whole spine evaluation is important to avoid missing other combined stenoses that may affect outcomes.

Download Full-text

Percutaneous full endoscopic posterior decompression of thoracic myelopathy caused by ossification of the ligamentum flavum

European Spine Journal ◽

10.1007/s00586-018-05866-2 ◽

2019 ◽

Vol 28 (3) ◽

pp. 492-501 ◽

Cited By ~ 10

Author(s):

Bo An ◽

Xing-Chen Li ◽

Cheng-Pei Zhou ◽

Bi-Sheng Wang ◽

Hao-Ran Gao ◽

...

Keyword(s):

Ligamentum Flavum ◽

Thoracic Myelopathy ◽

Posterior Decompression

Download Full-text

Repeated recurrence of thoracic spine stenosis following decompression alone for ossification of the ligamentum flavum: case report

Journal of Neurosurgery Spine ◽

10.3171/2018.8.spine18517 ◽

2019 ◽

Vol 30 (3) ◽

pp. 332-336

Author(s):

Abhijeet S. Barath ◽

Osmond C. Wu ◽

Mohit Patel ◽

Manish K. Kasliwal

Keyword(s):

Clinical Presentation ◽

Ligamentum Flavum ◽

Surgical Intervention ◽

Review Of The Literature ◽

Thoracic Myelopathy ◽

Posterior Decompression ◽

Instrumented Fusion ◽

Intervertebral Level ◽

Multiple Recurrences ◽

Variable Clinical Presentation

Ossification of the ligamentum flavum (OLF) is a well-recognized but rare cause of thoracic myelopathy. Its subtle and variable clinical presentation often makes the diagnosis challenging. The treatment of symptomatic OLF requires surgical intervention, with the most common surgical procedure being a posterior decompression with or without instrumentation. Recurrence of ossification and stenosis after surgery is rare and usually occurs at the same intervertebral level. Multiple recurrences of ossification and stenosis are exceptionally rare. The authors report the case of OLF in a 60-year-old man who experienced recurrence of ossification and stenosis twice after posterior decompression surgeries alone. The patient was ultimately treated with revision decompression and instrumented fusion. The authors also present a pertinent review of the literature.

Download Full-text

Microendoscopic posterior decompression for the treatment of thoracic myelopathy caused by ossification of the ligamentum flavum: a technical report

European Spine Journal ◽

10.1007/s00586-015-4158-9 ◽

2015 ◽

Vol 25 (6) ◽

pp. 1912-1919 ◽

Cited By ~ 16

Author(s):

Satoshi Baba ◽

Yasushi Oshima ◽

Tomoyuki Iwahori ◽

Yuichi Takano ◽

Hirohiko Inanami ◽

...

Keyword(s):

Ligamentum Flavum ◽

Thoracic Myelopathy ◽

Posterior Decompression ◽

Technical Report

Download Full-text

Retrospective comparison of the surgical results for patients with thoracic myelopathy caused by ossification of the posterior longitudinal ligament: Posterior decompression with instrumented spinal fusion versus modified anterior decompression through a posterior approach

Journal of Orthopaedic Science ◽

10.1016/j.jos.2021.01.001 ◽

2021 ◽

Author(s):

Toshimi Aizawa ◽

Ko Hashimoto ◽

Haruo Kanno ◽

Kyoichi Handa ◽

Kohei Takahashi ◽

...

Keyword(s):

Spinal Fusion ◽

Posterior Approach ◽

Posterior Longitudinal Ligament ◽

Surgical Results ◽

Anterior Decompression ◽

Thoracic Myelopathy ◽

Posterior Decompression ◽

Retrospective Comparison

Download Full-text

Posterior decompression with transforaminal interbody fusion for thoracic myelopathy due to ossification of the posterior longitudinal ligament and the ligamentum flavum at the same level

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2012.04.016 ◽

2013 ◽

Vol 20 (4) ◽

pp. 570-575 ◽

Cited By ~ 7

Author(s):

Fa-Jing Liu ◽

Yi Chai ◽

Yong Shen ◽

Jia-Xin Xu ◽

Wei Du ◽

...

Keyword(s):

Interbody Fusion ◽

Ligamentum Flavum ◽

Posterior Longitudinal Ligament ◽

Thoracic Myelopathy ◽

Posterior Decompression ◽

Transforaminal Interbody Fusion

Download Full-text

Surgical results of nonambulatory patients caused by ossification of the posterior longitudinal ligaments in the thoracic spine: retrospective comparative study between posterior decompression and instrumented spinal fusion versus anterior decompression through a posterior approach

Journal of Neurosurgery Spine ◽

10.3171/2020.7.spine20411 ◽

2020 ◽

pp. 1-6

Author(s):

Toshimi Aizawa ◽

Toshimitsu Eto ◽

Ko Hashimoto ◽

Haruo Kanno ◽

Eiji Itoi ◽

...

Keyword(s):

Spinal Fusion ◽

Posterior Approach ◽

Japanese Orthopaedic Association ◽

Case Series ◽

Walking Ability ◽

Surgical Results ◽

Anterior Decompression ◽

Thoracic Myelopathy ◽

Retrospective Case ◽

Posterior Decompression

OBJECTIVEThoracic myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) remains one of the most difficult-to-treat disorders for spine surgeons. In Japan, approximately 75% of patients with this condition are treated using posterior decompression with instrumented spinal fusion (PDF). In contrast, anterior decompression is the most effective method for relieving spinal cord compression. The authors treated nonambulatory patients with thoracic OPLL by either PDF or by their technique using anterior decompression through a posterior approach. In this study the surgical results of these procedures are compared.METHODSThis was a retrospective case series. From 2008 to 2018, 9 patients with thoracic OPLL who could not walk preoperatively were treated surgically. Three patients were treated by PDF (the PDF group) and 6 patients were treated by anterior decompression through a posterior approach (the modified Ohtsuka group). The degree of surgical invasion and the neurological conditions of the patients were assessed.RESULTSThe PDF group had a shorter operative duration (mean 477 ± 122 vs 569 ± 92 minutes) and less intraoperative blood loss (mean 613 ± 380 vs 1180 ± 614 ml), although the differences were not statistically significant. The preoperative Japanese Orthopaedic Association (JOA) score was almost identical between the two groups; however, the latest JOA score and the recovery rate were significantly better in the modified Ohtsuka group than in the PDF group (8.8 ± 1.5 vs 5.0 ± 1.7 and 71.3% ± 23.7% vs 28.3% ± 5.7%, respectively). The walking ability was evaluated using the modified Frankel scale. According to this scale, 3 patients showed three grade improvements, 2 patients showed two grade improvements, and 1 patient showed one grade improvement in the modified Ohtsuka group. Three patients in the modified Ohtsuka group could walk without any support at the final follow-up.CONCLUSIONSThe present study clearly indicated that the surgical outcomes of the authors’ modified Ohtsuka procedure were significantly better than those of PDF for patients who could not walk preoperatively.

Download Full-text

Posterior decompression with kyphosis correction for thoracic myelopathy due to ossification of the ligamentum flavum and ossification of the posterior longitudinal ligament at the same level

Journal of Neurosurgery Spine ◽

10.3171/2010.3.spine09237 ◽

2010 ◽

Vol 13 (1) ◽

pp. 116-122 ◽

Cited By ~ 26

Author(s):

Hong-Qi Zhang ◽

Ling-Qiang Chen ◽

Shao-Hua Liu ◽

Di Zhao ◽

Chao-Feng Guo

Keyword(s):

Thoracic Kyphosis ◽

Ligamentum Flavum ◽

Posterior Instrumentation ◽

Japanese Orthopaedic Association ◽

Posterior Longitudinal Ligament ◽

Thoracic Myelopathy ◽

Posterior Decompression ◽

Decompressive Laminectomy ◽

Kyphosis Correction

Object The object of this study was to evaluate the efficacy and safety of posterior decompression with kyphosis correction for thoracic myelopathy due to ossification of the ligamentum flavum (OLF) and ossification of the posterior longitudinal ligament (OPLL) at the same level. Methods Between January 2003 and December 2005, 11 patients (8 men and 3 women) with thoracic myelopathy due to OLF and OPLL at the same level underwent posterior decompressive laminectomy and excision of OLF. Posterior instrumentation was also performed for stabilization of the spine and reducing the thoracic kyphosis angle by approximately 5–15° (kyphosis correction), and spinal fusion was performed in all cases. The follow-up period ranged from 2 to 4 years (mean 2.8 years). The outcomes were evaluated using a recovery scale based on the Japanese Orthopaedic Association classification. The score of each patient was calculated before surgery, 1 year after surgery, and at the final follow-up visit. Results After surgery, the thoracic kyphosis in the stabilization area was reduced from 30.0 ± 4.02° to 20.8 ± 2.14° on average. The mean score on the Japanese Orthopaedic Association scale improved from 3.5 ± 1.69 preoperatively to 8.5 ± 1.63 at the final follow-up, with a recovery rate of 68.0%. The results were good in 9 patients and fair in 2 patients. Postoperative MR imaging showed that the spinal cord was shifted posteriorly and decompressed completely in all cases. Myelopathy was not aggravated in any case after surgery. Conclusions A considerable degree of neurological recovery was observed after posterior decompression and kyphosis correction. The procedure is easy to perform with a low risk of postoperative paralysis. The authors therefore suggest that the procedure is useful for patients whose spinal cords are severely impinged by OLF and OPLL at the same level.

Download Full-text

Factors for a Good Surgical Outcome in Posterior Decompression and Dekyphotic Corrective Fusion with Instrumentation for Thoracic Ossification of the Posterior Longitudinal Ligament: Prospective Single-Center Study

Operative Neurosurgery ◽

10.1093/ons/opx043 ◽

2017 ◽

Vol 13 (6) ◽

pp. 661-669 ◽

Cited By ~ 10

Author(s):

Shiro Imagama ◽

Kei Ando ◽

Kazuyoshi Kobayashi ◽

Tetsuro Hida ◽

Kenyu Ito ◽

...

Keyword(s):

Spinal Cord ◽

Surgical Outcomes ◽

Ligamentum Flavum ◽

Posterior Longitudinal Ligament ◽

Neurophysiological Monitoring ◽

Posterior Decompression ◽

Thoracic Spinal Cord ◽

Thoracic Spinal ◽

Estimated Blood Loss ◽

Significant Factors

Abstract BACKGROUND Surgery for thoracic ossification of the posterior longitudinal ligament (T-OPLL) is still challenging, and factors for good surgical outcomes are unknown. OBJECTIVE To identify factors for good surgical outcomes with prospective and comparative study. METHODS Seventy-one consecutive patients who underwent posterior decompression and instrumented fusion were divided into good or poor outcome groups based on ≥50% and <50% recovery rates for the Japanese Orthopaedic Association score. Preoperative, intraoperative, and postoperative findings were compared in the 2 groups, and significant factors for a good outcome were analyzed. RESULTS Patients with a good outcome (76%) had significantly lower nonambulatory rate and positive prone and supine position tests preoperatively; lower rates of T-OPLL, ossification of the ligamentum flavum, high-intensity area at the same level, thoracic spinal cord alignment difference, and spinal canal stenosis on preoperative magnetic resonance imaging; lower estimated blood loss; higher rates of intraoperative spinal cord floating and absence of deterioration of intraoperative neurophysiological monitoring; and lower rates of postoperative complications (P < .0005). In multivariate logistic regression analysis, negative prone and supine position test (odds ratio [OR]: 17.00), preoperative ambulatory status (OR: 6.05), absence of T-OPLL, ossification of the ligamentum flavum, high-intensity area at the same level (OR: 5.84), intraoperative spinal cord floating (OR: 4.98), and lower estimated blood loss (OR: 1.01) were significant factors for a good surgical outcome. CONCLUSION This study demonstrated that early surgery is recommended during these positive factors. Appropriate surgical planning based on preoperative thoracic spinal cord alignment difference, as well as sufficient spinal cord decompression and reduction of complications using intraoperative ultrasonography and intraoperative neurophysiological monitoring, may improve surgical outcomes.

Download Full-text